GENERAL SURGERY
GENERAL SURGERY
Embedded Files
SMALL BOWEL OBSTRUCTION
SMALL BOWEL OBSTRUCTION
Introduction
5 minIntroduction
Introduce yourself and the group
Provide rationale for the session and relevance to clinical practice
Outline learning objectives:
- Demonstrate focused history taking and abdominal examination from a patient with suspected small bowel obstruction
- Suggest relevant imaging required to aid diagnosis of small bowel obstruction
- Suggest initial management of small bowel obstruction
- Recognise common causes of small bowel resection
Explain structure of session
Total time:
60 minNumber of students:
1-5Grade of students:
3rd to 5th year medical studentsCreated by:
Dr Harriet MitchellUploaded:
20th September 2019Last updated:
20th September 2019Resources needed for this session:
Resources needed for this session:
Students can scan the QR code opposite to view all investigation results on their phone as you work through the session.
Resources linked to this session:
Resources linked to this session:
Activity 1: History Taking and Examination Skills
20 minActivity 1: History Taking and Examination Skills
Ask students to take a focused history and perform the relevant abdominal examination from a patient with suspected small bowel obstruction (20 minutes maximum). This can be observed if capacity of tutors allows.
Activity 2: Case-Based Discussion and Diagnostic Reasoning
10 minActivity 2: Case-Based Discussion and Diagnostic Reasoning
Ask students to present the key findings of the case they have seen and suggest a few key differential diagnoses. Provide feedback on presentation style (max 1 min).
Discuss with the student(s):
- Which differential diagnosis is most likely and why?
- What initial investigations would be useful to aid diagnosis? What are they expected to show?
Activity 3: Initial investigations
5 minActivity 3: Initial investigations
Allow students to view the patient's abdominal x-ray. If none is available, use the example opposite. Students can view this on their phones if needed by scanning the QR code.
Discuss with students:
- What is the key abnormality on the abdominal x-ray?
- How is it possible to differentiate between small and large bowel obstruction on a plain abdominal x-ray?
- What further imaging may be helpful?
- When is a CT indicated?
- What are the risks/considerations before requesting a CT?
Activity 4: Advanced Imaging
5 minActivity 4: Advanced Imaging
If possible, review the patient's CT abdomen/pelvis with students. If none is available, use the example opposite. Students can scan the QR code to view the image on their phone.
Orientate them and ask them to point our a few key structures e.g.
- kidneys
- vertebral column
- small bowel
Ask the student(s) to point out any obvious abnormalities.
Activity 5: Further Management
15 minActivity 5: Further Management
Ask students to consider how they would manage this patient acutely. Consider:
- supportive management
- specific management
- medical management
- surgical management
Activity 6: Fluid Prescribing
10 minActivity 6: Fluid Prescribing
Ask students to find a drug chart and prescribe appropriate fluids for the patient. Allow the students to view the patient's latest blood results. If none are available, use the example below:
Patient EX is normotensive and not tachycardic, but is vomiting frequently. Their latest blood tests showed:
Na+ 144
K+ 3.2
Urea 8.1
eGFR 82mls/min
Summary and Feedback
5 minSummary and Feedback
Questions
Identify and summarise key learning points (key three points if possible)
Feedback to student – highlight further learning needs
Feedback for teacher - ask students to provide feedback using the QR code opposite
Close
References and Further Reading
References and Further Reading
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